Psychologist: Components Of Pain Complicated And Changeable

Pain is never a simple matter for psychologist James B. Wade, who practices at the Pain Management Center of the Medical College of Virginia.

The physical sensation of injury is only the beginning of the experience, he says, and - especially for people suffering from chronic pain - it may not be the most important ingredient.

Writing in a recent issue of the Journal of Pain, Wade describes the pain phenomenon as a bundle of physical, emotional and behavioral components that is far more complicated and changeable than generally believed.

In addition to the physical sensation itself, for example, he and other researchers have identified a second stage of perception characterized by such feelings as dizziness, nausea and fatigue. Studies have shown that this "pain-related immediate unpleasantness," as Wade describes it, can vary considerably in intensity from the actual pain.

So, too, can the level of suffering, which Wade breaks down into such variable emotional components as anger, fear, frustration, anxiety and depression. Equally important to this third stage of perception is the victim's mental appraisal of the impact the pain will have on his or her life.

Culture, family background, personality style and the context of the pain can all exhibit a dramatic influence on suffering, resulting in wide differences in its intensity.

Doctors have observed for years, for example, that labor pain rarely causes the same level of misery experienced by patients with other types of physically trying afflictions. Injuries suffered in a combat zone, likewise, seldom provoke the demand for painkillers seen with identical wounds in civilian life.

Such large perceptual differences have led researchers to focus more and more on the role of the mind in governing the pain experience.

Hypnosis, biofeedback and other relaxation techniques, for example, have proved helpful in treating chronic pain, which may be closely linked to undetected states of high psychophysiological arousal.

Some research suggests that these techniques may work in other ways, too, actually reducing the physical sensation of acute pain and tissue damage in some cases.

"People with a high hypnotic ability can stop pain," says psychologist Ian Wickram, who studies the links between the body and mind at Norfolk's Eastern Virginia Medical School.

"They can even stop surgical pain while lying on the operating room table."